Health literacy on tuberculosis amongst vulnerable segment of population: special reference to Saharia tribe in central India.

Background & objectives: Health literacy on tuberculosis (TB) is an understanding about TB to perform activities with regard to prevention, diagnosis and treatment. We undertook a study to assess the health literacy on TB among one of the vulnerable tribal groups (Saharia) in central India. Methods: In this cross-sectional study, 2721 individuals aged >15 yr from two districts of Madhya Pradesh state of India were interviewed at their residence during December 2012-July 2013. By using a short-form questionnaire, health literacy on cause, symptoms, mode of transmission, diagnosis, treatment and prevention of TB was assessed. Results: Of the 2721 (Gwalior 1381; Shivpuri 1340) individuals interviewed; 76 per cent were aged <45 yr. Living condition was very poor (62% living in huts/katcha houses, 84 per cent with single room, 89 per cent no separate kitchen, 97 per cent used wood/crop as a fuel). Overall literacy rate was 19 per cent, and 22 per cent had >7 members in a house. Of the 2721 respondents participated, 52 per cent had never heard of TB; among them 8 per cent mentioned cough as a symptom, 64 per cent mentioned coughing up blood, and 91 per cent knew that TB diagnosis, and treatment facilities were available in both government and private hospitals. Health literacy score among participants who had heard of TB was <40 per cent among 36 per cent of respondents, 41-60 per cent among 54 per cent and >60 per cent among 8 per cent of respondents. Interpretation & conclusions: The finding that nearly half of the respondents had not heard of TB indicated an important gap in education regarding TB in this vulnerable population. There is an urgent need to implement targeted interventions to educate this group for better TB control.

Situation of drug resistant tuberculosis in Saharia tribe of central India.

Background & objectives: The information on multidrug resistant tuberculosis (MDR-TB) situation amongst Saharia, one of the Particularly Vulnerable Tribal Groups (PVTGs) in Madhya Pradesh, India, is not available. Hence, this study was undertaken to find the situation of MDR-TB amongst Saharia PVTG in two districts of Madhya Pradesh. Methods: Community based cross-sectional TB prevalence surveys were conducted among Saharia PVTG in Gwalior and Shivpuri districts of Madhya Pradesh. Chest symptomatics were identified from the individual registered for the study. Two sputum samples were collected from each of the eligible individuals, transported to the laboratory, and were examined by Ziehl-Neelsen (Z-N) smear microscopy and solid medium culture methods. Drug susceptibility testing of the isolates was done by indirect proportion method on solid medium. Results: MDR rate was 2.2 per cent of new cases and 8.2 per cent among the previously treated cases of TB in Gwalior while it was two per cent among the previously treated cases in Shivpuri district. Interpretation & conclusions: Though the prevalence of tuberculosis in these districts was alarmingly high, the MDR rates were more or less similar to national average. However, the findings of this study highlight the need for active intervention so that the MDR-TB is kept under control.

Pulmonary tuberculosis - a health problem amongst Saharia tribe in Madhya Pradesh.

Background & objectives: The information on tuberculosis (TB) situation amongst Saharia, one of the particularly vulnerable tribal groups (PVTGs) in Madhya Pradesh, is not available from Gwalior division of the state. Hence, this study was undertaken to estimate the prevalence of pulmonary tuberculosis (PTB) disease amongst them. Methods: A community based cross-sectional TB prevalence survey was undertaken among Saharia PVTG in Gwalior district of Madhya Pradesh. A random sample of villages predominated by Saharia tribe was selected from all the blocks in proportion to the size of Saharia population in each block of the district. All eligible individuals were questioned for chest symptoms relating to TB. Two sputum samples were collected from each of the eligible individuals, transported to the laboratory, and were examined by Ziehl-Neelsen(ZN) smear microscopy and solid media culture methods. Results: Of the total 10,259 individuals eligible for screening, 9,653 (94.1%) were screened for symptoms. Overall prevalence of PTB was found to be 3294 per 100,000. The prevalence increased with age and the trend was significant (p<0.001). The prevalence of TB was significantly higher amongst males (5497/100,000) as compared to females (1376/100,000) (p<0.001). Interpretation & conclusions: The study results provide vital information on the current situation of pulmonary TB disease among the Saharia tribal community in Gwalior district of Madhya Pradesh. In view of high PTB disease prevalence among this PVTG, there is an urgent need to improve and further intensify TB control measures in this area.

Performance of Revised National Tuberculosis Control Programme (RNTCP) in tribal areas in India.

Background & objectives: The Revised National Tuberculosis Control Programme (RNTCP) provides free diagnostic and treatment services to all tuberculosis (TB) patients registered under it. Equitable access, implying a preference for the most hard-to-reach groups particularly for tribal areas, is a major concern for RNTCP. This study was conducted to assess the performance of RNTCP in terms of case detection and cure rates in areas dominated by tribal groups in India. Methods: We used the RNTCP data collected by the Central TB Divison, Government of India. RNTCP has a systematic monitoring mechanism which tracks the outcome of every patient put on treatment. There is a standardized recording and reporting structure in place; indicators are monitored regularly at every level of the health system; and regular supervision ensures quality of the programme. The main indicators include the number of cases diagnosed and the percentage of patients who are successfully treated. these indicators were used to assess the RNTCP performance in tribal areas. Results: We observed a poor performance in terms of case detection rate (CDR) in tribal and backward districts as compared with other districts in India. Among tribal districts 53 per cent in 2010, 45 per cent in 2011 and 56 per cent in 2012 had CDR of new smear positive <70%. It was also observed that 26 per cent of tribal dominated districts had CDR of <51 per cent in 2012. More than 50 per cent of tribal districts were not able to achieve more than 85 per cent of cure rate. Interpretation & conclusions: The findings of this study suggested that the overall RNTCP performance in tribal areas was not optimal, and the target of >85 per cent of core rate was achieved by less than half of the tribal districts.

Knowledge and attitude towards tuberculosis amongst the tribal population of Jhabua, Madhya Pradesh.

Summary: A community-based cross-sectional survey was carried out amongst the tribal population of Jhabua in Madhya Pradesh. A total of 1385 individuals from randomly selected villages were interviewed using structured questionnaire. Eighty five per cent respondents had knowledge of the symptoms of tuberculosis. About a quarter of the respondents were not aware of any method for preventing TB. Though majority of the respondents (68.2%) stated that TB is a curable disease, most of them (67.2%) were not aware of the DOTS programme. The study emphasizes the need for extensive health education programme to create awareness about tuberculosis in tribal population of the region.

Annual Risk of Tuberculosis Infection Among the Tribal Children of Jhabua, Madhya Pradesh.

A cross sectional tuberculin survey was undertaken to estimate the Annual Risk of Tuberculosis Infection (ARTI) amongst tribal children aged 1-9 years in Jhabua district, Madhya Pradesh, India. Of the 1056 test-read children, 774 (73.3 %) had no BCG scar. The prevalence of infection was estimated as 6.3% (95% CI: 4.8-7.7) and ARTI as 1.2 % (95% CI: 0.9-1.5). The findings suggest that the tuberculosis situation in the tribal population of Jhabua district is not that different from the situation among the non-tribal population in the country. However, there is a need to further intensify tuberculosis control measures in the area.

Prevalence of pulmonary tuberculosis amongst thebaigas A primitive tribe of Madhya Pradesh, Central India.

Background: A community-based cross-sectional tuberculosis (TB) disease prevalence survey was undertaken amongst the Baiga primitive tribal community of Baiga Chak in central India. Material and Methods: A population of 2,359 was covered under the study. Sputum samples were collected from chest symptomatics and examined for smear microscopy and culture. Results: Overall prevalence of PTB was 146 (95% C.I: 0 - 318) per 100,000 population. Conclusion: The findings suggest that TB is not a major public health problem amongst this tribal group. However, there is still the need to maintain and further strengthen TB control measures on a sustained and long term basis in the area.

Undernutrition & childhood morbidities among tribal preschool children.

BACKGROUND & OBJECTIVE: Undernutrition and various morbidities go hand in hand, particularly in children. Nutritional status is a sensitive indicator of community health and nutrition. The present study is an attempt to assess the nutritional status of pre-school children of Gond tribal community in Madhya Pradesh. METHODS: The study was a community-based, cross- sectional survey carried out in tribal preschool children. Anthropometric measurements were taken. Various indices of nutritional status were expressed in standard deviation units (z scores) from the reference median. The children were examined for nutritional deficiencies and other morbidities. The haemoglobin concentration was measured and the children were classified into various grades of nutritional anaemias. Data on socio-cultural and hygienic practices were also collected. RESULTS: More than 60 per cent children were underweight. Micronutrient deficiency disorders such as anaemia and vitamin A deficiency were common among them. Unhygienic personal habits and adverse cultural practices relating to child rearing, breast-feeding and weaning were also prevalent among them. INTERPRETATION & CONCLUSION: The findings of the present study revealed the widespread prevalence of undernutrition among pre-school tribal children and highlight a need for an integrated approach towards improving the child health as well as nutritional status in this area.

Worm infestation and anaemia: a public health problem among tribal pre-school children of Madhya Pradesh.

A study to assess the status of intestinal parasitosis and anaemia was carried out among the pre-school children of Gond tribal community in Kundam block of Jabalpur district, Madhya Pradesh. A total of 985 pre-school children were covered. The results revealed that 48% pre-school children had intestinal parasitic infections. Common parasites observed among them were Hymenolepis nana, hookworms and roundworms. Mean epg for these parasites ranged from 371.2 to 1221.8. High prevalence of anaemia (86.7%) was also observed among them. This high prevalence of intestinal parasitic infections and anaemia could be due to indiscriminate defecation, low socio-economic status, ignorance and low standard of personal hygiene. Comprehensive control strategy with specific intervention measures need to be evolved and implemented specially in tribals as serious efforts are being madeby the Govt. for their overall development.

Nutritional deficiency disorders and high mortality among children of the Great Andamanese tribe.

BACKGROUND: The population of the Great Andamanese tribe of the Andaman Islands has been declining at a rapid pace. The case fatality rate during a recent outbreak of dysentery was 30.8%, all the deaths being among under-fives. As malnutrition is known to potentiate susceptibility to death due to infectious diseases, we undertook a study to determine the prevalence of malnutrition among the Great Andamanese tribe and its role in contributing to the high mortality among them due to infectious diseases. METHODS: The study included a diet survey, nutritional anthropometry, clinical examination, haemoglobin estimation and stool examination for intestinal parasitic infestations. Information was also collected about every pregnancy in all ever-married women in the community and deaths of their children. All 36 members of the tribe were covered. RESULTS: The Andamanese had a poor intake of iron, vitamin A and riboflavin but a good intake of energy, protein and fats. More than 85% of the children below 6 years were under-nourished and more than 77% of children and adolescents below 19 years were stunted, wasted or both. Anaemia, vitamin A deficiency and goitre were also common among them. Almost the entire population suffered from intestinal parasitic infestations. They also have a comparatively high fertility rate and a high infant mortality rate. CONCLUSION: The population attributable risk for death due to malnutrition is probably one of the foremost reasons for the observed high infant mortality rate among the Great Andamanese tribe and could be one of the reasons for the continuous decline in their population.

Filariasis control in rural areas through detection and treatment with diethylcarbamazine.

A pilot study for control of bancroftian filariasis through detection and treatment of microfilaria (mf) carriers and filaria disease cases with Diethylcarbamazine (DEC) undertaken in the rural areas of Srikakulam and Vizianagaram of Andhra Pradesh showed that this chemotherapeutic method of control of filaria in rural areas is feasible and acceptable to society. During first round of detection and treatment 20,300 mf carriers (90.6 per cent of detected) and 6,588 disease persons (86 per cent of detected) in Srikakulam and 7,097 mf carriers (94.8 per cent of detected) and 1,436 disease persons (93.4 per cent of detected) in Vizianagaram were treated with DEC tablets. These areas were again surveyed after five years and detected cases were treated with DEC with coverage of treatment ranging from 82.3 per cent to 95 per cent for both mf & disease cases and decline in mf and disease rate was noted to be 52.4 per cent and 50.9 per cent respectively in Srikakulam and 42.2 per cent for mf rate in Vizianagaram. The mf reduction was appreciably high (50 per cent or more) in 11 PHCs of Srikakulam and 4 PHCs of Vizianagaram. The mf rate reduction was the highest in the age group of 1 to 4 year indicating that the transmission has been cut down significantly. The vector infection rate showed reduction by 50 per cent during second round of detection and treatment as compared to first round, indicating significant reduction in transmission potential.